In response to the uncertain external environment, trust leaders said the biggest risk is the 'perfect storm' of workforce shortages, staff burnout, a second wave of coronavirus and a difficult winter. This all needs to be considered within the context of a possible no deal Brexit, which could add further complications for the NHS in terms of supply chains and staff recruitment and retention.

Following the first wave of the pandemic, winter planning began earlier than ever and trusts across England feel they have done everything they possibly could do to plan and prepare for the coming months. However, with COVID infections and hospital admissions rising throughout September, many leaders are concerned about sustaining levels of planned care and addressing growing waiting lists.

All trust leaders recognise the contribution of their staff and are working tirelessly to support and help build resilience across the workforce. This is clearly a major concern, however, in an uncertain external environment and with further increases in demand for NHS services highly likely.